Patient Compliance

Patients coming to the hospital for appointments and elective surgery should be informed in advance of the tobacco-free campus wide status by their healthcare provider. Notice of the tobacco-free status should be added to all patient forms. Patients should be advised, encouraged, counseled, and supported in quitting the use of all tobacco products. They will heal and recover better and faster if they have quit smoking. They should be encouraged to either quit or start using the nicotine replacement therapy (NRT) patch several weeks before their appointment and to stay on the NRT patch or gum during their hospital stay. Some will try to quit as a result of abstaining from tobacco products for a few days.

• Patient Agreement Form – Patients and their families can be asked to sign a form that states that they are aware of the tobacco-free campus wide policy and that they agree to comply with it. The signed copy should be placed in the patient’s medical record.
  
  
• Standing Orders for Nicotine Replacement Therapy (NRT) Patch – Standing orders should be ready in the hospital, especially in the Emergency Department. All incoming patients that identify themselves as tobacco users should be informed of the policy and encouraged to start using the NRT patch immediately. They should be given a handout that explains the proper use of the NRT gum and lozenges.
  
  
• Referrerd to the NC Quitline using the fax referral form in english or spanish. This allows the Quitline to call the patient, guarenteeing follow up, and is used for people ready to quit within the next 30 days. Anyone can call the NC Quitline for free 7 days a week from 8:00 a.m. until midnight.
  
  
• Control of Patient Movement – Some patients will want to use tobacco products even if it means leaving the campus. In order to control the spread of infections within the hospital and to lessen the chance of liability suits, it is recommended that hospitals prohibit patients from leaving the hospital and grounds without the permission of their physician.
  
  

  Inpatients Can Not Leave Hospital
  UNC Hospitals has developed a policy that prohibits inpatients from leaving the hospital to smoke, or for any other reason. This helps to ensure patient safety - reactions to medications, problems with IV pumps, and patient injury due to vehicle traffic and construction can easily happen when a patient is off the hospital grounds. This also lessens the chance of a liability suit caused by a patient getting injured. Patients leaving the campus also pose an infection control issue as they may acquire or spread bacteria / viruses, by either moving within the hospital or while off campus.  This can place the patient, other patients and staff at risk.

At UNC Hospitals, if a patient insists on leaving the campus to smoke, an Against Medical Advice (AMA) form is completed and the patient is discharged from the hospital. In order to re-enter, the patient must be readmitted through the admitting or emergency department. Because re-entry through the ED is such an onerous process, it is expected that this policy will deter patients from leaving AMA to use tobacco. Staff members at UNC are discouraged from allowing their patients to leave the hospital campus.  In the event that a staff member does issue physician orders permitting a patient to leave the property to smoke, that staff member remains responsible for the patient’s welfare and safe return to the hospital. Click here to see UNCs policy memo on inpatients. For more information see UNC Hospitals’ toolkit used for training hospital employees about the policy.

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